Acceptability of anonymous reporting is linked to goals of system; anonymous reporting acceptable if goal is to accumulate data for future action but not workable if goal is to take action.

System should protect the identity of users and assure them of confidentiality.

Scope and range—Voluntary vs. mandatory reporting

System should be voluntary.

Levels of Operation

Most stakeholders favor a multilevel system in which reports "roll up" from the local level to State, regional, or national levels.

Opinions about levels of operation linked to goals of system. Local-level reporting important to provide immediate feedback to health care facility and institute rapid change. Higher-level reporting important for accountability and system-wide learning.

Some stakeholders suggested the reporting system be implemented in stages or tested in pilot programs.

Organizations suitable to operate consumer reporting systems

Many stakeholders favored Federal government agencies and private/independent/nonprofit organizations. Advantages of government are neutrality and authority; disadvantages are potential to become politicized and government inefficiency.

Mixed views about hospitals and health care institutions; have experience collecting patient safety data and will be more readily accepted by providers; consumer advocates opposed because not a safe place for consumers to report, and institutions can skew data.

Little support for consumer advocacy organizations because would be challenging to get buy-in from health care professionals.

Primary goals are organizational-level and system-wide learning and improving quality of care/patient safety (closely linked); also support for consumer empowerment.

Less support for accountability as goal, which would duplicate existing organizations and mechanisms; also focus on punishment could undermine trust and partnership needed for effective system.

Linkages to quality improvement

Stakeholders generally supported linking to existing efforts to improve quality and patient safety. They did not suggest linking to programs that offer financial incentives for quality (pay-for-performance models) or providing feedback to health care facilities or providers.

Maximizing reporting

Communication efforts needed in health care institutions (e.g., at intake) and public information campaigns; also work through trusted community organizations and employers.

Communication about system should convey importance of consumer reporting to improve patient safety.